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Case selection for a Medicaid chronic care management program.

Weir S, Aweh G, Clark RE - Health Care Financ Rev (2008)

Bottom Line: Medicaid agencies are beginning to turn to care management to reduce costs and improve health care quality.We find that the ACG-PM model performs best.However, for predicting the very highest-cost members (e.g, the 99th percentile), the DCG model is preferred.

View Article: PubMed Central - PubMed

Affiliation: Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA 01545, USA. sharada.weir@umassmed.edu

ABSTRACT
Medicaid agencies are beginning to turn to care management to reduce costs and improve health care quality. One challenge is selecting members at risk of costly, preventable service utilization. Using claims data from the State of Vermont, we compare the ability of three pre-existing health risk predictive models to predict the top 10 percent of members with chronic conditions: Chronic Illness and Disability Payment System (CDPS), Diagnostic Cost Groups (DCG), and Adjusted Clinical Groups Predictive Model (ACG-PM). We find that the ACG-PM model performs best. However, for predicting the very highest-cost members (e.g, the 99th percentile), the DCG model is preferred.

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Percentage of All High-Cost Members Found in Top 10 Percent Risk Group, by Actual Year 2 Cost Threshold
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f2-hcfr-30-01-061: Percentage of All High-Cost Members Found in Top 10 Percent Risk Group, by Actual Year 2 Cost Threshold

Mentions: Examining the percentage of all high-cost members that are found in the top 10 percent risk group (Figure 2), we find that the ACG-PM™ model selects the highest percentage of all year 2 high-cost members when evaluated at the 50th - 90th percentile cost thresholds. The ACG-PM™ and DCG models pick similar percentages at the 95th percentile, and the DCG model picks the highest percentage at the 99th percentile. When the top 1 percent risk group is considered (Figure 3), the ACG-PM™ and DCG models perform similarly up to the 90th percentile cost threshold, but the DCG model picks higher percentages of high-cost members at the 95th and 99th percentile cost thresholds.


Case selection for a Medicaid chronic care management program.

Weir S, Aweh G, Clark RE - Health Care Financ Rev (2008)

Percentage of All High-Cost Members Found in Top 10 Percent Risk Group, by Actual Year 2 Cost Threshold
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4195045&req=5

f2-hcfr-30-01-061: Percentage of All High-Cost Members Found in Top 10 Percent Risk Group, by Actual Year 2 Cost Threshold
Mentions: Examining the percentage of all high-cost members that are found in the top 10 percent risk group (Figure 2), we find that the ACG-PM™ model selects the highest percentage of all year 2 high-cost members when evaluated at the 50th - 90th percentile cost thresholds. The ACG-PM™ and DCG models pick similar percentages at the 95th percentile, and the DCG model picks the highest percentage at the 99th percentile. When the top 1 percent risk group is considered (Figure 3), the ACG-PM™ and DCG models perform similarly up to the 90th percentile cost threshold, but the DCG model picks higher percentages of high-cost members at the 95th and 99th percentile cost thresholds.

Bottom Line: Medicaid agencies are beginning to turn to care management to reduce costs and improve health care quality.We find that the ACG-PM model performs best.However, for predicting the very highest-cost members (e.g, the 99th percentile), the DCG model is preferred.

View Article: PubMed Central - PubMed

Affiliation: Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA 01545, USA. sharada.weir@umassmed.edu

ABSTRACT
Medicaid agencies are beginning to turn to care management to reduce costs and improve health care quality. One challenge is selecting members at risk of costly, preventable service utilization. Using claims data from the State of Vermont, we compare the ability of three pre-existing health risk predictive models to predict the top 10 percent of members with chronic conditions: Chronic Illness and Disability Payment System (CDPS), Diagnostic Cost Groups (DCG), and Adjusted Clinical Groups Predictive Model (ACG-PM). We find that the ACG-PM model performs best. However, for predicting the very highest-cost members (e.g, the 99th percentile), the DCG model is preferred.

Show MeSH
Related in: MedlinePlus